The One Big Beautiful Bill Act (H.R. 1), which passed the House by just one vote—with Rep. Jeff Van Drew voting yes—made deep cuts to Medicaid that the Congressional Budget Office estimated would leave about 8 million people without coverage and reduce federal Medicaid funding by roughly $800 billion over ten years. The bill also imposed new work requirements and stricter eligibility rules that experts say will cause millions more to lose insurance through red tape and churn. After the Senate passed it 50–50 and the Vice President broke the tie, the bill was signed into law on July 4, 2025. CBO now projects it will leave around 10 million more people uninsured by 2034 and slash more than $1 trillion from federal health programs.
- The Congressional Budget Office (via CRS) estimated the House‑passed One Big Beautiful Bill Act (H.R. 1) would reduce federal Medicaid outlays by about $840.2 billion over FY2025–34 and increase the number of people without insurance by 7.8 million due to its Medicaid provisions. (congress.gov)
- KFF’s summary of CBO’s score for the House‑passed bill likewise found $793 billion in federal Medicaid cuts and 7.8 million more uninsured from the Medicaid provisions alone. (kff.org)
- After enactment, CBO projected the law would leave roughly 10 million more people uninsured in 2034 and reduce federal health spending by about $1.06 trillion from Medicaid and Marketplace changes. (aha.org)
- AP reported CBO’s finding that the new law increases deficits and leaves “over 10 million” uninsured, with more than $1 trillion in savings coming from health cuts including new Medicaid work requirements. (apnews.com)
- Prior to final passage, CBO estimated the package would ultimately reduce health coverage by 10.9 million, including roughly 8 million fewer Medicaid enrollees and 5.2 million losing Medicaid under new work requirements. (apnews.com)
- FactCheck.org’s breakdown of the CBO analysis confirms that 7.8 million of the projected increase in the uninsured in 2034 stems specifically from the bill’s Medicaid provisions. (factcheck.org)
- On May 22, 2025, the House passed H.R. 1 by 215–214–1 (Roll Call 145). (clerk.house.gov)
- The same roll call shows Rep. Jeff Van Drew voted “Yea.” (clerk.house.gov)
- Because the margin was one vote, the bill would have failed had any one “yea” switched; thus each “yea,” including Van Drew’s, was a deciding vote. (clerk.house.gov)
- On July 3, 2025, the House agreed to the Senate amendment to H.R. 1 by 218–214 (Roll Call 190). (clerk.house.gov)
- The roll call lists Van Drew voting “Aye” on final House passage. (clerk.house.gov)
- The Senate passed the bill 50–50, with the Vice President casting the tie‑breaking vote on July 1, 2025, underscoring the measure’s razor‑thin margins at every stage. (senate.gov)
¶ The bill became law and contains explicit Medicaid restrictions that drive coverage losses
- H.R. 1 was signed July 4, 2025 as Public Law 119–21. (govinfo.gov)
- The law requires states to establish Medicaid “community engagement” (work) requirements for certain adults (Sec. 71119), a policy CBO linked to millions losing coverage. (govinfo.gov)
- The law tightens procedural eligibility rules (including address verification and eligibility redeterminations), which increase churn and terminations (e.g., Secs. 71103–71107). (govinfo.gov)
- CBO’s post‑enactment breakdown attributes major Medicaid savings to freezing provider taxes and reducing state‑directed payments—policies that pressure state Medicaid financing and coverage. (aha.org)